A preliminary analysis of this year’s surveys of licensed physicians in Hawaiʻi shows that the supply of working doctors has decreased by more than a hundred doctors in just one year.

Of particular concern is that a big chunk of those doctors left the state.

The updated 2019 Hawaiʻi Physician Workforce data was presented at this past weekend’s Health Workforce Summit, hosted annually by the University of Hawaiʻi Mānoa (UHM) John A. Burns School of Medicine (JABSOM) Hawaiʻi Pacific Basin Area Health Education Center (AHEC).

Kelley Withy, MD, PhD, AHEC Executive Director and Principal Investigator of the Workforce Report, said the current supply of licensed doctors who are working full-time, according to the preliminary data, is 2,819 physicians statewide. There are 108 fewer practicing physicians than at this same time last year. Her data show that 49 physicians retired the past year — perhaps not surprising given that well over a quarter of Hawaiʻi doctors are past the age of 60. Another 58 physicians reduced their work hours, entering into semi-retirement. But the number that got a lot of attention was the one showing that at least 39 doctors left the state.

“The stressors physicians are facing have increased dramatically the last 20 years,” said JABSOM Dean Jerris Hedges, MD. “There is no doubt that the environment for practicing medicine has changed and the pace of that change is happening more quickly.”

Some of the changes began with increased documentation expectations required for care reimbursement and use of Electronic Medical Records to provide that detailed and often redundant documentation. Additional requirements for process based “quality metrics” attached to government regulations or reforms imposed by providers of health insurance have added to physicians’ administrative burden. Increased patient care reporting requirements (some unique to each insurance company) take additional time away from seeing patients, in some cases requiring practitioners to hire additional staff to help with those tasks. “For example, there are five different Medicaid insurance carriers in Hawaiʻi alone,” Hedges said, each with its own physician credentialing and patient documentation/quality metric requirements to be met.

Increasingly doctors will seek out large physician practice groups where third parties in the practice can do more of this administrative burden. Were there only one insurance entity, the burden would be more reasonable, but with multiple insurance companies the administrative burden adds up, and impacts career choices.” said Hedges.

Dr. Withy said in her summits, which draw upwards of 500 physicians from all over the state annually, doctors repeatedly mention that what they need most urgently is increased reimbursements from Medicare, Quest and private insurers.

Further, the medical school and state leaders have moved forward to ease the economic burden on physicians in several areas. A Hawaiʻi State Loan Repayment Program fund has been established to help ease the educational loan burden of doctors and some other health care professionals who agree to work in Hawaiʻi‘s needy health care areas. A Hawaiʻi“Preceptor Tax Credit has been approved by the state to assist some private health professionals who train learners in their practice.

There is also a need to train more physicians who are prepared to practice in a transformed healthcare environment. The medical school has taken in more students, and in the works, is an ambitious plan to branch out year-round teaching on the neighbor islands. JABSOM has increased admission in every incoming class since 2010, expanding the entering class size from 62 students to 77 without adding faculty or new classrooms. Now the University and medical school hope to get permission from the Regents to ask the Legislature to support the teaching of medical students across all 4 years on Hawaiʻi Island and Maui. A state investment of about $1.4 million per site annually would be required, primarily to support additional faculty and staff. The learning classrooms would be provided using existing UH facilities on the neighbor islands and clinical settings would evolve through JABSOM’s partnerships with health care providers on each island.

The Shortage: Oʻahu and Neighbor Island Points of Note
Other data from the Workforce Summit provided snapshots of how dire the situation looks when it comes to specialty care on neighbor islands, meaning in emergencies patients must travel to another island, usually Oʻahu. The numbers even paint a sober picture regarding the supply of general practice family medicine doctors on Oʻahu itself. On Kauaʻi, the data show there are no island-based specialists in infectious disease, critical care, neonatal-perinatal care, neurological surgery, geriatrics, allergy/immunology, rheumatology, endocrinology, or physical medicine and rehabilitation. Maui had no island-based neurosurgeons (though reports it just recently added two), but still lacks colorectal surgeons; Hawaiʻi Island has no island-based neonatal-perinatal care doctors, none in infectious disease or colorectal surgery. On Oʻahu, it is getting more difficult than ever to find a general and family practice doctor — with a 46% shortage of those physicians based on need according to the population of the City and County of Honolulu. Other high shortage specialties in Honolulu are infectious disease, pulmonology and pathology.

The 2019 Hawaiʻi Health Workforce Report will be finalized between now and December, when it will be submitted to the Hawaiʻi State Legislature. Through the state, a fee is attached to the issuance of doctor’s licenses in Hawaiʻi to support the annual survey and efforts by JABSOM to support working physicians’ well being. The legislature adopted the annual survey out of its concern over our already critical physician shortages in some parts of the state, coupled with projections that our aging population will need more medical services in the future, not fewer.